title: Acute kidney injury is surprisingly common and a powerful predictor of mortality in surgical sepsis.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a common and often catastrophic complication in hospitalized patients; however, the impact of AKI in surgical sepsis remains unknown. We used Risk, Injury, Failure, Loss, End stage (RIFLE) consensus criteria to define the incidence of AKI in surgical sepsis and characterize the impact of AKI on patient morbidity and mortality.
  
  
  METHODS
  Our prospective, institutional review board-approved sepsis research database was retrospectively queried for the incidence of AKI by RIFLE criteria, excluding those with chronic kidney disease. Patients were grouped into sepsis, severe sepsis, and septic shock by refined consensus criteria. Data including demographics, baseline biomarkers of organ dysfunction, and outcomes were compared by Student's t test and χ test. Multivariable regression analysis was performed for the effect of AKI on mortality adjusting for age, sex, African-American race, elective surgery, Acute Physiology and Chronic Health Evaluation II score, septic shock versus severe sepsis, and sepsis source.
  
  
  RESULTS
  During the 36-month study period ending on December 2010, 246 patients treated for surgical sepsis were evaluated. AKI occurred in 67% of all patients, and 59%, 60%, and 88% of patients had sepsis, surgical sepsis, and septic shock, respectively. AKI was associated with Hispanic ethnicity, several baseline biomarkers of organ dysfunction, and a greater severity of illness. Patients with AKI had fewer ventilator-free and intensive care unit-free days and a decreased likelihood of discharge to home. Morbidity and mortality increased with severity of AKI, and AKI of any severity was found to be a strong predictor of hospital mortality (odds ratio, 10.59; 95% confidence interval, 1.28-87.35; p = 0.03) in surgical sepsis.
  
  
  CONCLUSIONS
  AKI frequently complicates surgical sepsis, and serves as a powerful predictor of hospital mortality in severe sepsis and septic shock.
  
  
  METHODS
  Prognostic and epidemiologic study, level III.
authors.forename: Laura E
authors.initials: LE
authors.lastname: White
authors.forename: Heitham T
authors.initials: HT
authors.lastname: Hassoun
authors.forename: Azra
authors.initials: A
authors.lastname: Bihorac
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Moore
authors.forename: R Matt
authors.initials: RM
authors.lastname: Sailors
authors.forename: Bruce A
authors.initials: BA
authors.lastname: McKinley
authors.forename: Alicia
authors.initials: A
authors.lastname: Valdivia
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D012772:Shock, Septic / Q000150:complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000009:adverse effects